Healthcare Provider Details

I. General information

NPI: 1790409977
Provider Name (Legal Business Name): MCKAYLA E CARTAGENA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 MAIN ST STE 101
CHESTER MD
21619-2792
US

IV. Provider business mailing address

1630 MAIN ST STE 101
CHESTER MD
21619-2792
US

V. Phone/Fax

Practice location:
  • Phone: 410-643-5789
  • Fax: 410-604-2490
Mailing address:
  • Phone: 410-643-5789
  • Fax: 410-604-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009029
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: